Successful thrombectomy in endocarditis-related stroke: Case report and review of the literature

Bolognese, Manuel; Hessling, Alexander von; Müller, Martin

doi:10.1177/1591019918774761

Cited by 16 publications

(6 citation statements)

References 19 publications

(16 reference statements)

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“…Previous studies demonstrated promising efficacy of MT in IE. 9,10,[15][16][17][18][19] These findings were also supported by the absence of difference in procedural time and complication rate in our study. Consequently, IE does not have to be considered as a limiting factor in MT feasibility in daily practice.…”

Section: Discussionsupporting

confidence: 88%

Safety and outcomes of mechanical thrombectomy for acute stroke related to infective endocarditis: A case–control study

Marnat

Sibon²,

Gory

et al. 2020

International Journal of Stroke

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Background and purpose Successful reperfusion can be achieved in more than two-thirds of patients with usual large-vessel occlusion stroke causes treated with mechanical thrombectomy. However, the safety and outcomes after mechanical thrombectomy in the setting of large-vessel occlusion related to infective endocarditis is not known. In this study, we investigated the impact of mechanical thrombectomy in infective endocarditis patients on angiographic and clinical outcomes. Methods This was a multicenter study from five comprehensive stroke centers. We compared the outcomes of mechanical thrombectomy treated stroke patients due to infective endocarditis with patients presenting atrial fibrillation. Clinical outcomes included 90-day modified Rankin Scale, symptomatic intracerebral hemorrhage, and mortality. Results Between June 2013 and March 2019, 28 patients presenting large-vessel occlusion stroke due to IE were included. These cases were matched with 84 large-vessel occlusion stroke related to atrial fibrillation. Successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b/3) was obtained in 85.7%. Symptomatic intracranial hemorrhage, favorable outcome and mortality rates were respectively 8.0%, 25.9%, and 25.9%. In the case–control analysis, we demonstrated no difference in terms of successful reperfusion, procedural complication, symptomatic intracranial hemorrhage, and mortality rates. Three-month favorable outcome was less often achieved in the infective endocarditis group. Conclusions Mechanical thrombectomy of infective endocarditis patients presents similar safety and angiographic results compared to patients suffering from atrial fibrillation.

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Section: Discussionsupporting

confidence: 88%

Safety and outcomes of mechanical thrombectomy for acute stroke related to infective endocarditis: A case–control study

Marnat

Sibon²,

Gory

et al. 2020

International Journal of Stroke

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“…The database search yielded 431 relevant records published until January 2020. Nineteen articles fulfilled the eligibility criteria [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Three articles (16%) were case series while sixteen (84%) were single case report.…”

Section: Resultsmentioning

confidence: 99%

Endovascular treatment of ischemic large-vessel stroke due to infective endocarditis: case series and review of the literature

D’Anna

2020

Neurol Sci

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Background Mechanical thrombectomy is the standard of care, in selected patients, for acute ischemic stroke with large vessel occlusion but its use in patients with stroke secondary to infective endocarditis is controversial. We report three cases of acute ischemic stroke treated by mechanical thrombectomy and we propose an extensive review of the literature to evaluate the clinical safety and efficacy of thrombectomy in patients with stroke secondary to infective endocarditis. Methods A comprehensive literature search was performed following a pre-specified protocol of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Case reports, cases series, cross-sectional studies, case control studies, randomized controlled trials or nonrandomized controlled trials were considered that included endocarditis-related acute ischemic stroke patients who underwent mechanical thrombectomy. Results The database search yielded 431 relevant records published until January 2020. Nineteen articles fulfilled the eligibility criteria that described thirty patients. After the thrombectomy, 13.3% of the patients experienced intracranial haemorrhage. After the procedure, the median National Institutes of Health Stroke Scale score dropped from 15 (IQR 7) to 2.5 (IQR 5.75). At 90 days, mortality was 23.3% while 46.7% of the patients were functionally independent (mRS ≤ 2). Discussion Based on our review, the use of mechanical thrombectomy in patients with large vessel occlusion due to endocarditisassociated stroke might improve patient outcome but it should be considered on a case by case base as the safety has not been well established yet. Further research on risk stratification is needed to drive clinician during the decision-making process.

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“…1 3 4 A less rigorous review by Bolognese and coworkers found a similar number of favorable outcomes, defined here as mRS score ≤3 in 69% of patients. 88 MT in patients with ELVO presumed to be the result of infective endocarditis has not been formally studied with a randomized controlled trial. Such a trial seems unlikely given the agreed-upon unfavorable outcome of the use of thrombolytic agents.…”

Section: Endocarditismentioning

confidence: 99%

Thrombectomy in special populations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

Al‐Mufti

Schirmer

Starke

et al. 2021

J NeuroIntervent Surg

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BackgroundThe purpose of this guideline is to summarize the data available for performing mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) stroke in special populations not typically included in large randomized controlled clinical trials, including children, the elderly, pregnant women, patients who have recently undergone surgery, and patients with thrombocytopenia, collagen vascular disorders, and endocarditis.MethodsWe performed a literature review for studies examining the indications, efficacy, and outcomes for patients undergoing MT for ischemic stroke aged <18 years and >80 years, pregnant patients, patients who have recently undergone surgery, and those with thrombocytopenia, collagen vascular diseases, or endocarditis. We graded the quality of the evidence.ResultsMT can be effective for the treatment of ELVO in ischemic stroke for patients over age 80 years and under age 18 years, thrombocytopenic patients, pregnant patients, and patients with endocarditis. While outcomes are worse compared to younger patients and those with normal platelet counts (respectively), there is still a benefit in the elderly (in both mRS and mortality). Data are very limited for patients with collagen vascular diseases; although diagnostic cerebral angiography carries increased risks, MT may be appropriate in carefully selected patients in whom untreated ELVO would likely result in disabling or fatal outcome.

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Successful thrombectomy in endocarditis-related stroke: Case report and review of the literature

Cited by 16 publications

References 19 publications

Safety and outcomes of mechanical thrombectomy for acute stroke related to infective endocarditis: A case–control study

Safety and outcomes of mechanical thrombectomy for acute stroke related to infective endocarditis: A case–control study

Endovascular treatment of ischemic large-vessel stroke due to infective endocarditis: case series and review of the literature

Thrombectomy in special populations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

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